Sikhosana Mpho Lerato, Suchard Melinda, Kuonza Lazarus, Cutland Clare, Slogrove Amy, Otwombe Kennedy, Motaze Nkengafac Villyen
South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, Johannesburg, Gauteng Province, South Africa (Drs Sikhosana and Kuonza).
Centre for Vaccines and Immunology, National Institute for Communicable Diseases, Johannesburg, Gauteng Province, South Africa (Drs Suchard and Motaze).
AJOG Glob Rep. 2022 Apr 15;2(3):100056. doi: 10.1016/j.xagr.2022.100056. eCollection 2022 Aug.
Preeclampsia is a considerable cause of maternal and infant morbidity and mortality. Although its etiology is unknown, preeclampsia has been described as a state of exaggerated maternal inflammatory response. Therefore, it has been hypothesized that preeclampsia would occur less commonly in states of immune deficiency.
This study aimed to compare the prevalence of treated and untreated HIV infections among preeclamptic cases and controls, determine infant outcomes, and evaluate the association between HIV and preeclampsia after adjusting for known predictor variables, including maternal age, gravidity, body mass index, and smoking.
This case-control study investigated the association between preeclampsia and HIV infection using secondary data from an unrelated study. We defined preeclamptic cases as pregnant women who were normotensive until 20 weeks of gestation and thereafter had at least 1 high blood pressure measurement either before or at delivery and proteinuria, defined as protein excretion of ≥300 mg within 24 hours or >2 protein on dipstick urinalysis. The prevalence of HIV infection was compared between cases and controls. Multivariate logistic regression analysis was used to assess the association between preeclampsia and potential confounding variables and reported using odds ratios and 95% confidence intervals.
There were 571 cases with preeclampsia and 596 normotensive controls included in this study. The median age was 27 years for cases and 26 years for controls (=.008). Most participants (69%) had ≥2 previous pregnancies with no difference between the cases and controls (=.176). Overall, 43% of the participants were obese, with a mean body mass index of 29 (interquartile range, 24.5-34.2), with higher proportions of women who were overweight and obese in the group with preeclampsia (=.031). The prevalence of HIV was significantly lower in cases than in controls (24% vs 30%, respectively; =.014). Compared with 16% of infants born preterm to normotensive controls, 48% of infants were born preterm born to women with preeclampsia (<.001). Compared with 14% of infants born with low birthweight to normotensive controls, 53% of infants were born with low birthweight to women with preeclampsia (<.0001). Untreated HIV infection was negatively associated with preeclampsia (unadjusted odds ratio, 0.330; 95% confidence interval, 0.197-0.552; <.0001), whereas factors associated with preeclampsia were advanced maternal age (odds ratio, 1.673; 95% confidence interval, 1.209-2.316; =.002) and obesity (odds ratio, 1.611; 95% confidence interval, 1.023-2.537; =.040). After adjusting for maternal age, gravidity, smoking, and body mass index in the multivariate regression, only obesity remained significantly associated with preeclampsia (adjusted odds ratio, 1.624; 95% confidence interval, 1.024-2.575; =.039).
Before the large-scale rollout of antiretroviral therapy in a setting with a high burden of HIV and preeclampsia, untreated HIV infection was found to have a protective effect against preeclampsia. The protective effect against preeclampsia was not apparent for HIV infection treated with antiretroviral therapy.
子痫前期是母婴发病和死亡的一个重要原因。尽管其病因尚不清楚，但子痫前期被描述为一种母体炎症反应过度的状态。因此，有人推测子痫前期在免疫缺陷状态下较少发生。
本研究旨在比较子痫前期病例和对照中已治疗和未治疗的HIV感染患病率，确定婴儿结局，并在调整已知预测变量（包括产妇年龄、妊娠次数、体重指数和吸烟情况）后评估HIV与子痫前期之间的关联。
本病例对照研究使用一项无关研究的二手数据调查子痫前期与HIV感染之间的关联。我们将子痫前期病例定义为妊娠20周前血压正常，此后在分娩前或分娩时至少有一次高血压测量值且有蛋白尿的孕妇，蛋白尿定义为24小时内蛋白质排泄量≥300mg或尿试纸分析显示蛋白>2个加号。比较病例组和对照组中HIV感染的患病率。采用多因素logistic回归分析评估子痫前期与潜在混杂变量之间的关联，并以比值比和95%置信区间报告。
本研究纳入了571例子痫前期病例和596例血压正常的对照。病例组的中位年龄为27岁，对照组为26岁（P=.008）。大多数参与者（69%）既往有≥2次妊娠，病例组和对照组之间无差异（P=.176）。总体而言，43%的参与者肥胖，平均体重指数为29（四分位间距，24.5 - 34.2），子痫前期组超重和肥胖女性的比例更高（P=.031）。病例组中HIV的患病率显著低于对照组（分别为24%和30%；P=.014）。与血压正常对照组中16%的早产婴儿相比，子痫前期女性所生婴儿中有48%早产（P<.001）。与血压正常对照组中14%的低出生体重婴儿相比，子痫前期女性所生婴儿中有53%低出生体重（P<.0001）。未治疗的HIV感染与子痫前期呈负相关（未调整比值比，0.330；95%置信区间，0.197 - 0.552；P<.0001），而与子痫前期相关的因素是高龄产妇（比值比，1.673；95%置信区间，1.209 - 2.316；P=.002）和肥胖（比值比，1.611；95%置信区间，1.023 - 2.537；P=.040）。在多因素回归中调整产妇年龄、妊娠次数、吸烟和体重指数后，只有肥胖仍与子痫前期显著相关（调整后比值比，1.624；95%置信区间，1.024 - 2.575；P=.039）。
在HIV和子痫前期负担较高的地区大规模推广抗逆转录病毒治疗之前，发现未治疗的HIV感染对子痫前期有保护作用。抗逆转录病毒治疗的HIV感染对子痫前期的保护作用不明显。
